Table 3.20DSM-IV to DSM-5 Psychotic Disorders

SchizophreniaA. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):

delusions

hallucinations

disorganized speech (e.g., frequent derailment or incoherence)

grossly disorganized or catatonic behavior

negative symptoms (i.e., affective flattening, alogia, or avolition)

SchizophreniaA. SAME with the exception that language expressing the negative symptoms has changed (e.g. affective flattening is now referred to as diminished emotional expression) and alogia is no longer presented as an example of a prominent negative symptom.

(Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other.)

B. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).

B. SAME

C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

C. SAME

D. Schizoaffective and mood disorder exclusion: Schizoaffective disorder and mood disorder with psychotic features have been ruled out because either (1) no major depressive, manic, or mixed episodes have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.

D. SAME

E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

E. SAME

F. Relationship to a pervasive developmental disorder: If there is a history of autistic disorder or another pervasive developmental disorder, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).

F. SAME

Schizophreniform DisorderA. A, D, and E of schizophrenia are met.

Schizophreniform DisorderA. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):

(D & E criteria of schizophrenia are included as C & D criteria of schizophreniform disorder.)

B. An episode of the disorder (including prodromal, active, and residual phases) lasts at least 1 month but less than 6 months. (When diagnosis must be made without waiting for recovery, it should be qualified as “Provisional.”)

B. SAME

Schizoaffective DisorderA. An uninterrupted period of illness during which, at some time, there is either a major depressive episode., a manic episode, or a mixed episode concurrent with symptoms that meet Criterion A for schizophrenia.

Schizoaffective DisorderA. SAME

B. During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.

B. SAME

C. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness.

C. SAME

D. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

D. SAME.

Delusional DisorderA. Nonbizarre delusions (i.e., involving situations that occur in real life, such as being followed, poisoned, infected, loved at a distance, or deceived by spouse or lover, or having a disease) of at least 1 month’s duration.

Delusional DisorderA. The presence of one (or more) delusions with a duration of 1 month or longer.

B. Criterion A for schizophrenia has never been met. Note: Tactile and olfactory hallucinations may be present in delusional disorder if they are related to the delusional theme.

B. SAME except for note: Hallucinations, if present, are not prominent and are related to the delusion theme (e.g., the sensation of being infested with insects associated with delusions of infestation.

C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired and behavior is not obviously odd or bizarre.

C. SAME

D. If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusional periods.

D. SAME

E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder.

Brief Psychotic DisorderA. Presence of one (or more) of the following symptoms:

delusions

hallucinations

disorganized speech (e.g., frequent derailment or incoherence)

grossly disorganized or catatonic behavior

Note: Do not include a symptom if it is a culturally sanctioned response pattern.

Brief Psychotic DisorderA. Presence of one (or more) of the following symptoms. At least one of these must be (1), (2), or (3):

delusions

hallucinations

disorganized speech (e.g., frequent derailment or incoherence)

grossly disorganized or catatonic behavior

Note: Do not include a symptom if it is a culturally sanctioned response pattern.

B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning.

B. SAME

C. The disturbance is not better accounted for by a mood disorder with psychotic features, schizoaffective disorder, or schizophrenia and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

C. The disturbance is not better explained by major depressive or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

Shared Psychotic Disorder (Folie á Deux)A. A delusion develops in an individual in the context of a close relationship with another person(s), who has an already-established delusion.B. The delusion is similar in content to that of the person who already has the established delusion.C. The disturbance is not better accounted for by another psychotic disorder (e.g., schizophrenia) or a mood disorder with psychotic features and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

DROPPED

Psychotic Disorder Due to a General Medical ConditionA. Prominent hallucinations or delusions.

Psychotic Disorder Due to Another Medical ConditionA. SAME

B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.

B. SAME

C. The disturbance is not better accounted for by another mental disorder.

C. SAME

D. The disturbance does not occur exclusively during the course of delirium.

D. SAME

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Substance-Induced Psychotic DisorderA. Prominent hallucinations or delusions. Note: Do not include hallucinations if the person has insight that they are substance induced.

Substance/Medication-Induced Psychotic DisorderA. Presence of one or both of the following symptoms:

Delusions

Hallucinations

B. There is evidence from the history, physical examination, or laboratory findings that either (1) or (2):

the symptoms in Criterion A developed during, or within a month of, substance intoxication or withdrawal

medication used is etiologically related to the disturbance

B. SAME

C. The disturbance is not better accounted for by a psychotic disorder that is not substance induced. Evidence that the symptoms are better accounted for by a psychotic disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g., about a month) after the cessation of acute withdrawal or severe intoxication, or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence that suggests the existence of an independent nonsubstance-induced psychotic disorder (e.g., a history of recurrent nonsubstance-related episodes).

C. SAME

D. The disturbance does not occur exclusively during the course of delirium.

D. SAMEE. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Psychotic Disorder Not Otherwise SpecifiedThis category includes psychotic symptomatology (i.e., delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior) about which there is inadequate information to make a specific diagnosis or about which there is contradictory information, or disorders with psychotic symptoms that do not meet the criteria for any specific psychotic disorder.

Unspecified Schizophrenia Spectrum and Other Psychotic DisorderThis category applies to presentations in which symptoms characteristic of a schizophrenia spectrum and other psychotic disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the schizophrenia spectrum and other psychotic disorders class. The unspecified schizophrenia spectrum and other psychotic disorder category is used in situations in which the clinician chooses not to communicate the specific reason that the presentation does not meet the criteria for any specific schizophrenia spectrum her psychotic disorder, and includes presentations in which there is insufficient information to make a more specific diagnosis (e.g., emergency room settings).Other Specified Schizophrenia Spectrum and Other Psychotic DisorderThis category applies to presentations in which symptoms characteristic of a schizophrenia spectrum and other psychotic disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the schizophrenia spectrum and other psychotic disorders class. The other specified schizophrenia spectrum and other psychotic disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific schizophrenia spectrum and other psychotic disorder. This is done by recording “other specified schizophrenia spectrum and other psychotic disorder” followed by the specific reason (e.g., persistent auditory hallucinations).

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